Provider Demographics
NPI:1710768387
Name:DANE, CHANNING (MA)
Entity Type:Individual
Prefix:
First Name:CHANNING
Middle Name:
Last Name:DANE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21781 VENTURA BLVD # 1024
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-1835
Mailing Address - Country:US
Mailing Address - Phone:818-725-6082
Mailing Address - Fax:
Practice Address - Street 1:6137 RYANS PL
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93536-1753
Practice Address - Country:US
Practice Address - Phone:818-688-6915
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-10
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA143146106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist